Menopause: It’s a time for celebration!
Today October 18, is World Menopause Day, a day to be celebrated by women all over the world. In Sri Lanka, menarche, or the onset of menstruation (menses or periods) in a young girl has been celebrated in style for generations, sometimes the entire village joining in the festivity. Though menstruation had been called “the curse”, and a menstruating woman was considered unclean, the end of menstruation or menopause, has never been given its due recognition anywhere in the world.
Angelina Jolie’s announcement that she was ‘in menopause’ at the age of 39 was seen as the bravest thing said by a Hollywood star. Pic courtesy AFP
The World Health Organization in collaboration with the International Menopause Society, has marked this day to turn the spotlight on the health of women after menopause. This day provides the opportunity to recognize menopause as an important event in a woman’s life, and create awareness about issues related to menopause while debunking myths and misunderstandings. The Menopause Society of Sri Lanka has taken the initiative in educating Sri Lankan women on menopause, so that this life event in women is no longer taboo, to be whispered behind closed doors, but is a topic women can confidently discuss in public.
What is menopause?
Menopause is the end of the reproductive life in a woman. A woman has two ovaries which produce one ovum (egg) each month, from the time a young girl attains menarche. Each egg can be fertilized if it encounters a sperm and a pregnancy can result. The ovaries with their developing eggs also produce sex hormones, mainly estrogen and progesterone, that are responsible for feminine attributes, maintaining a pregnancy and helping the breasts to form breast milk. However if a pregnancy does not occur, the inner lining (endometrium) of the womb which had been made ready to receive a pregnancy, is shed as menstrual blood during the ‘menses’. The ovaries however, have only a limited number of eggs, and by the late thirties and forties the quality of eggs become poor, and by the late forties or early fifties the egg supply is over. This marks the end of the ‘menses’, and also puts a stop to the production of ovarian estrogen and progesterone. The ending of eggs in ovaries leading to the absence of menstruation is called the menopause.
Is menopause an illness?
No. Menopause is a natural event like puberty or menarche. Most women worldwide reach menopause at the age of 51 years. To diagnose menopause, there should be absence of menstruation for 12 months. However menopause occurring before 40 years (premature menopause) is abnormal, and needs treatment. If ovaries are surgically removed before natural menopause, it is called “surgical menopause”. Cessation of menstruation in a young woman who had her womb removed (hysterectomy) is not menopause as long as at least one of her ovaries is functioning. Women who smoke cigarettes reach menopause earlier than non-smokers.
What are the problems associated with menopause?
Menopause brings about a number of problems, mostly because the woman’s ovaries fail to produce enough estrogen. Some problems may begin a few years before menopause. These include hot flushes, irregular bleeding, osteoporosis, sexual dysfunction, urogenital problems, increase in weight, expanding waist line, and increased risk of diabetes, high cholesterol, high blood pressure, heart attacks and cancer. Moreover, psychological disturbances such as depression are also known to increase at this time. However, most problems can be successfully managed by healthy lifestyle approaches, health education, counselling, medicines and sometimes surgery.
Does menopause mark the end of good life?
Certainly not! Of course when a woman experiences some problems at the time of menopause she may feel that it all goes downhill from there. However, there are obvious advantages of menopause; there is freedom from menses which has inconvenienced the woman from her young days and the fear of pregnancy is no more, and many women feel that they are free to enjoy life. The troublesome symptoms experienced close to menopause such as irregular bleeding, body aches and hot flushes, disappear or become less with time.
Women also come to terms with the change in appearance and develop more self-confidence. Most problems associated with menopause can be managed by lifestyle measures or other means.
What are the lifestyle measures available to manage problems associated with menopause?
With the increase in life expectancy of women to approximately 78 years, many women now live over one third of their lives after menopause. It is thus essential that women remain healthy if they are to enjoy life after menopause. Promoting healthy lifestyle practices, with proper nutrition and increased leisure and physical activity, are effective in managing weight gain, heart disease and osteoporosis. Furthermore, healthy lifestyle improves psychological well-being, physical appearance, symptom control and the overall health of a woman.
Diet and Nutrition
The diet should contain adequate calories and nutrients required for healthy living, and be rich in calcium and vitamin D to prevent osteoporosis. Calorie restriction is important if overweight. Snacking between meals is discouraged as the snacks are usually ‘empty calories’ full of sugar and oil.
Regular physical activity
Regular physical activity provides a myriad of health benefits and is necessary for postmenopausal women to remain active, healthy and independent. Exercise improves energy levels, muscle strength, blood cholesterol, blood pressure, bone strength and cardiovascular fitness and results in weight loss and a slimmer waist. Aerobic exercise (eg. walking, swimming) combined with weight-bearing exercise (eg. jogging) for 30-40 minutes daily on 5 days of the week is satisfactory, though daily exercise is more desirable.
Weight control
Weight reduction improves obesity, high blood pressure and heart disease. This is accomplished by diet and physical exercise. The aim is to maintain a body mass index (weight(kg)/ height (m)2) of 18.5-23kg/m2 and a waist size <80 cm.
What are the other treatments available?
Hormone replacement therapy (HRT) containing estrogens with or without progesterone is useful to treat troublesome hot flushes and some other symptoms. HRT offers protection from heart disease, stroke and osteoporosis as well. There is a slight increase in the risk of breast cancer and a few other diseases which limit its use. HRT should be started with or soon after menopause to be fully effective.
Vaginal dryness and urinary problems may benefit from estrogen creams or pessaries. Osteoporosis can be treated with calcium and vitamin D supplementation and medicines such as bisphosphonates. Standard treatment is available for high blood pressure, cholesterol and blood glucose. Screening will help in early detection of cancers, diabetes, high blood pressure and lipid disorders.
As effective treatment is available in most instances, women after menopause should not hesitate in seeking treatment from the nearest government hospital or their doctor for any complaint.
What is it like to live beyond menopause in Sri Lanka?
It is interesting to note that for the Asian woman menopause is much less of a problem than for the European woman. There are ample examples from Asian countries to show that women after menopause enjoy better lives than many premenopausal counterparts –for example many Asian women leaders such as prime ministers, professionals and businesswomen came to limelight only late in life, and well after menopause. Many professional women reach the peak of their careers after menopause. The ordinary older women of many Eastern cultures have a high place of respect and regard in families and communities.
The Menopause Society of Sri Lanka is ready to extend support to women with problems and free healthcare is provided by government hospitals for all women after menopause. So menopause for Sri Lankan women could mark the beginning of a better life, and indeed a time for celebration!
The writer is Secretary, Menopause Society of Sri Lanka Specialist Physician and Senior lecturer in Physiology, Faculty of Medicine, University of Colombo